Short summary

Steroids and asparaginase are used in treatment of childhood ALL and lymphoma. Both drugs can induce hyperglycemia. We investigate the incidence and severity of glucose intolerance and medicine-induced diabetes during treatment. Blood glucose are measured using continuous glucose monitoring system (CGM). Blood samples are drawn to measure insulin sensitivity and beta cell function. The results may give rise to a new guideline for measuring and treating hyperglycemia in these patients.

Rationale

Acute lymphoblastic leukemia (ALL) is the most common malignant disease in childhood. Lymphomas are rare in childhood, but become more frequent in adolescence. The overall survival of acute lymphoblastic leukemia (ALL) and lymphoma in children and adolescents is above 90%. The survival rate has increased significantly during the last decades as a consequence of more intensive chemotherapy. This very toxic treatment results in severe acute toxicities and late effects, which is the biggest challenge today besides survival. The overall purpose of contemporary ALL treatment is to reduce the toxic treatment without compromising the excellent survival rates of these diseases. Steroids and asparaginase are used in the treatment of childhood ALL and lymphomas, and both drugs may induce glucose intolerance or diabetes, especially when they are given concomitantly. In the current Western European ALL protocol (ALLTogether), in which the Nordic Countries participate anthracyclines are omitted for more than 50% of the patient for the prevention of cardiac late effects, and instead the treatment of asparaginase is advanced compared to previous Nordic/Baltic treatment protocols and thus given concomitant with steroids, like in some lymphoma protocols. Knowledge of the influence of this on the glucose metabolism and possible late effects is lacking. Hyperglycemia during treatment is associated with increased risk of infections and with increased severity of the infections. There also seems to be an increased risk of metabolic syndrome and type 2 diabetes in ALL patients who have suffered from medication-induced diabetes during treatment. The aim of the study is to investigate the incidence and severity of glucose intolerance and medicine-induced diabetes during treatment for ALL and lymphoma.

Description of the cohort

The participants are children and adolescents (1.0-17.9 years) with newly diagnosed ALL or lymphoma treated in one of the four Danish pediatric oncology sites.

Data and biological material

Blood samples Continuous glucose monitoring Data from the patient journal

Collaborating researchers and departments

Department of pediatric and adolescents medicine, Aarhus University Hospital

• Chief physician, professor, main supervisor in the PhD project Birgitte Klug Albertsen

Department of pediatric and adolescents medicine, Odense University Hospital

• Chief physician Peder Skov Wehner

Department of pediatric and adolescents medicine, Aalborg University Hospital

• Chief physician Marianne Olsen
• Senior registrar Christina Friis Jensen

Department of pediatric and adolescents medicine, University Hospital Rigshospitalet

• Senior registrar Raheel Altaf Raja
• Chief physician Lisa Lyngsie Hjalgrim